U.S. patent number 4,913,132 [Application Number 07/254,312] was granted by the patent office on 1990-04-03 for myringotomy instrument.
Invention is credited to Noble Gabriel.
United States Patent |
4,913,132 |
Gabriel |
April 3, 1990 |
Myringotomy instrument
Abstract
A hand held myringotomy instrument comprises an otoscope and an
attached laser beam generator section. The laser beam generator
section comprises a portion for moving the laser beam generator of
the section along the laser beam axis, in order to adjust the
position of the focus of the laser beam nearer, or father from the
instrument. Preferably, the moving portion includes an inner sleeve
carrying the generator and an outer sleeve respectively inside and
outside of a tube connected to the otoscope. A pair of elements
diametrically opposed attached to the inner tube project through
longitudinal slots diametrically opposed in the tube and are
externally threaded to mesh with internal threads on the outer
sleeve. The slots restrict the motion of the elements to axial
motion. Collars restrict the motion of the outer sleeve to
rotational motion. Thus, rotation of the outer sleeve causes
longitudinal motion of the elements which moves the laser beam lens
system carried by the inner sleeve axially along the laser beam
axis as desired.
Inventors: |
Gabriel; Noble (Chelmsford,
MA) |
Family
ID: |
26943971 |
Appl.
No.: |
07/254,312 |
Filed: |
October 6, 1988 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
890485 |
Jul 25, 1986 |
|
|
|
|
Current U.S.
Class: |
600/200; 606/14;
606/17; 607/89 |
Current CPC
Class: |
A61B
1/227 (20130101); A61B 18/201 (20130101); A61F
11/002 (20130101); A61B 90/30 (20160201); A61B
17/24 (20130101); A61B 2017/00172 (20130101); A61B
2017/00787 (20130101) |
Current International
Class: |
A61B
18/20 (20060101); A61F 11/00 (20060101); A61B
1/227 (20060101); A61B 17/24 (20060101); A61B
19/00 (20060101); A61B 17/00 (20060101); A61B
001/22 () |
Field of
Search: |
;128/4,6,9,303.14,303.15,303.1,395,398 ;353/101 ;350/255
;372/101 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
Soderbery et al.; "Myringotomy Made by CO.sub.2 Laser An
Alternative to the Ventilation Tube"; 1984; pp. 335-341. .
Wilpizeski et al.; "Otological Applications of Lasers: Basic
Background"; pp. 185-192. .
Goode; "CO.sub.2 Laser Myringotomy"; 1982; pp. 420-423. .
Goode; "For Serious Otitis Media, Laser Myringotomy?"; 1979; p.
709. .
Schwartz; "Myringotomy: A Neglected Office Procedure"; 1979; pp.
102-108. .
Gates; "The Role of Myringotomy in Acute Otitis Media"; 1984; pp.
391-397. .
Laxford et al.; "Myringotomy and Ventilation Tubes: A Report of
1568 Ears"; 1982; pp. 1293-1297..
|
Primary Examiner: Coven; Edward M.
Assistant Examiner: Graham; Mark S.
Attorney, Agent or Firm: Pearson & Pearson
Parent Case Text
This is a continuation of Ser. No. 890,485, filed 7/15/86, now
abandoned.
Claims
I claim:
1. A hand-held myringotomy instrument comprising:
an otoscope comprising a housing having a proximal end and a distal
end, an optical lens system having an ocular lens at the proximal
end and having an optical axis, and a speculum at the distal end,
whereby an observer may view through the ocular lens from the
proximal end along the optical axis a desired area near and beyond
the distal end;
a tube rigidly connected to the housing;
a laser beam source for providing a laser beam along a beam path
within the tube;
a lens system for focusing the laser beam at a focal point a
certain distance from the laser lens system;
means for moving the entire laser lens system along the laser beam
axis of the laser beam to move the laser beam focal point along the
laser beam path;
a laser beam reflector in the otoscope interposed diagonally in the
laser beam path axis and diagonally in the optical lens axis to
redirect by reflection the laser beam coincidentally with the
otoscope lens system optical axis toward the otoscope distal end,
the laser beam leans system focusing the laser beam at a point
beyond the otoscope distal end;
whereby an operator may observe from the proximal end the area at
which the laser beam is directed near the distal end of the
otoscope and by said moving means adjust the point of focus along
the laser beam axis.
said means for moving the laser beam lens system comprising an
inner sleeve carrying the laser beam leans system inside the
tube;
an outer sleeve about the tube internally threaded and restricted
to rotation about the tube;
a traveling element fastened to the inner tube and externally
threaded to mesh with the outer sleeve internal threads;
the tube having a longitudinal slot within which the elements
projects, and said slot restricting the element to axial motion
along the tube, whereby rotation of the outer sleeve moves the
element axially, and the attached inner sleeve axially thereby to
move axially the laser beam lens system carrier by the inner
sleeve.
2. A myringotomy instrument as claimed in claim 1 wherein:
said reflector comprises a quartz plate having a polished
reflecting surface to reflect the laser beam.
3. A myringotomy instrument as claimed in claim 1 wherein:
said reflector comprises a steel plate having a polished reflecting
surface to reflect the laser beam.
4. A myringotomy instrument as claimed in claim 1 further
comprising:
a second traveling element fastened to the inner sleeve
diametrically opposed to the first element and externally threaded
to mesh with the outer sleeve internal threads;
the tube having a second longitudinal slot diametrically opposed to
the first slot within which the second element projects, and said
second slot restricting the motion of the second element to axial
motion along the tube, thereby promoting a balanced axial motion of
the inner sleeve.
5. A myringotomy instrument as claimed in claim 1 further
comprising:
a light source, and an optical fiber bundle placed in said otoscope
to direct diffused light from the bundle toward the distal end of
the otoscope.
Description
FIELD OF THE INVENTION
The invention relates generally to otoscopes and the like, and more
particularly to an instrument for performing myringotomies.
BACKGROUND OF THE INVENTION
One of the preferred treatments for serous otitis media (SOM) is
myringotomy, particularly in cases in which treatment with
antibiotics have failed to overcome the underlying infection. One
method of performing myringotomy is by incision with a knife, for
example, as described by Dr. Richard H. Schwartz in "Myringtomy: A
neglected Office Procedure", in AFP for Dec. 1979. Recently there
have been cases in which the myringotomy is performed by using a
laser. See also the article in Pediatric Annals entitled "The Role
of Myringotomy in Acute Otitis Media" by George A. Gates, dated May
5, 1984, p. 391; and an article by Luxford, et al, entitled
"Myringotomy and Ventilation Tubes: A Report of 1,586 Ears" in
"Laryngoscope 92, Nov., 1982, p. 1293. Recently it has been
suggested that the myringotomy may be accomplished by the use of a
laser. For example, as described by Richard L. Goode in
Laryngoscope 92: Apr., 1982, p. 420; and also in a note in Journal
of American Medical Association, v. 242, No. 88, Aug. 24-31, 1979,
p. 709; and in "Otological Applications of Lasers: Basic
Background" by Chester Wilpizeski, et al. Further, "Myringotomy
Made by CO.sub.2 Laser--an Alternative to the Ventilation Tube?",
and experimental study by Solderberg, et al in Acta Otolaryngol
(Stockh) 1984, 97: 335-341.
Also, of possible interest note the following U.S. Pat. Nos.
2,098,702 to Gagnon, Nov. 9, 1937 for Diagnostic Instrument,
disclosing a hand held otoscope with a light source for ear
examination; 3,020,912 to Chester, Feb. 13, 1962, for Motor Driven
Surgical Knife which describes a motor driven knife for performing
myringotomy.
Also, the following: U.S. Pat. No. 3,865,114, Feb. 11, 1974 to
Sharon, for "Laser Device Particularly Useful as a Surgical
Instrument" which describes a surgical laser with a mechanical
shield to prevent excess radiation; U.S. Pat. No. 3,982,541 to
L'Esperance, Jr., Sept. 28, 1976, for Eye Surgical Instrument which
describes the use of a carbon dioxide (CO.sub.2) laser for
surgically removing surface portions of an eye, such as cataract
tissue; U.S. Pat. 4,006,738 to Moore, Feb. 8, 1977, for Otoscope
Construction which describes a halogen lamp for providing
illumination for an otoscope; U.S. Pat. No. 4,106,493 to Proctor,
et al, Aug. 15, 1978, for "Biphasic Otoscopic Air Stimulator for
Performing Clinical Caloric Tests" describing an instrument and
method of testing by bathing the tympanum and surrounding external
tissue in fluid of predetermined temperature; U.S. Pat. No.
4,211,229 to Wurster, July 8, 1980, for Laser Endoscope, which
describes the insertion of a laser and lens system in an endoscopic
sheath; and U.S. Pat. No. 4,366,811 to Riester, Jan. 4, 1983, for
Otoscope with Ejector Mechanism which describes an otoscope with a
readily ejected ear funnel.
SUMMARY OF THE INVENTION
According to the invention, an otoscope and a laser beam generator
are combined in a single instrument suitable for holding in the
hand. The laser is rigidly connected to the otoscope. A reflector
is provided arranged in the otoscope diagonally to the optical axis
of the otoscope, and to the optical axis of the laser to reflect
the laser beam along the line of sight of, and toward the distal
end of the otoscope. Therefore, the operator or surgeon who is
preparing to perform a myringotomy can view the operating field
through the otoscope, and at the same time observe the effects of
the laser beam surgery. The laser beam generator is adjustable in
the tube in which it is held axially for adjusting the proper place
of focus, rather than adjusting the focal length, thereby achieving
a close adjustment.
By making the instrument hand-held, it may be used more accurately,
and with the adjustment described with better control than
manipulating separate instruments or adjusting focal length. The
reflector may comprise ground and polished quartz, or a stainless
steel element polished to a mirror surface. The otoscope may
include means for providing a dispersed illumination of the viewing
area, and if desired a suction tube for withdrawing exudate, or the
like.
DESCRIPTION OF THE DRAWINGS
The various objects, advantages and novel features of the invention
will be more fully understood from a reading of the following
detailed description when read in connection with the accompanying
drawing, in which like reference numerals refer to like parts, and
in which:
FIG. 1 is a central longitudinal cross-sectional view, partly
schematic, of the combined otoscope and laser instrument of the
invention;
FIG. 2 is a partial sectional view, slightly enlarged, of a detail
of FIG. 1, illustrating the adjustment means; and
FIG. 3 is an alternative to means of FIG. 1 for providing diffuse
illumination for the otoscope of FIG. 1.
DETAILED DESCRIPTION OF DRAWING
Referring to FIG. 1, the myringotomy instrument 10 comprises an
otoscope 11, and a laser beam generator section 12, which may be a
carbon dioxide (CO.sub.2) laser or other, for example, an Argon
laser. The otoscope comprises a housing 14, ocular lens at lens
systems 15 in the housing 14, and a threaded adjustment 16 in the
housing for moving the ocular lens 15 forward or back, in the
direction of the optical axis 17 of the lens 15. The housing leads
from the lens 15 in the proximal end 23 toward the distal end 24,
where the housing terminates in a speculum, or opening, 18, which
may, if desired, be removable by any suitable expedient, here shown
as simply attached by a slight frictional and inherent spring
attachment. At its distal end 24, the speculum terminates in an
opening 18. Shown in dashed lines are the human eye 20 of the
operator, and the ear lobe 21 of a patient as they might appear
with the instrument in place. The tympanum of the ear which is to
be the subject of the myringotomy is shown at 22.
The laser section 12 comprises a laser beam generator and power
source indicated schematically at 26 to generate the laser beam
which may be batteries within the tube, or a power converter for
converting the usual ac electrical supply to the requisite laser
supply, such as dc, and is therefore, supplied by the usual plug 27
for connection to any suitable outlet. A tube 30 contains the
generator 26, and the tube 30 is rigidly connected to the otoscope
housing 14. The housing 14 has an opening at 31 to receive the beam
38 from the laser generator 26. A mirror 25 may be provided for use
with an external laser beam generator and/or a power source 47 and
external laser beam 48.
A plastic hand grip 32 may surround and be attached to the tube 30,
and furnished with external grooves 35 so that the hand may fit
comfortably around the grip. The tube 30 carries an outer sleeve
33, and an inner sleeve 34. The inner sleeve 34 (see also FIG. 2)
carries the generator 26 within the tube 30. A laser lens system
indicated by the single lens 37 is carried also by the inner sleeve
34 as part of the laser generator 26. The outer sleeve 33 is
internally threaded as at 39 to match and mesh with similar threads
40 and 40a on the outer surfaces of a pair of traveling elements 41
and 41a on diametrically opposite sides of tube 30. Although one
element would be operable, the two opposite elements 40 and 40a
tend to avoid possible canting of the inner sleeve 34, and thus
enable smoother operation. The inner sleeve 34 slides inside the
tube 30 in a close sliding fit. On diametrically opposite sides in
tube 30, a pair of longitudinal, axial slots 45 and 45a receive
respectively the traveling elements 41 and 41a. The elements 41 and
41a may slide only axially longitudinally in the slots 45 and 45a
in which they fit closely. Consequently, when the outer sleeve 33
is rotated about the tube 30, the traveling elements 41 and 41a are
forced to follow the slots longitudinally. The elements 41 and 41a
have projections 46 and 46a inserted, such as by screwing into the
inner tube 34. Therefore, as the traveling elements 41 and 41a
travel axially, they carry the inner sleeve 34 axially with them. A
pair of collars 49 having an upper collar 50, and a lower collar
51, respectively above and below the outer sleeve 33, restrain the
outer sleeve 33 from axial motion and permit only rotational motion
of the outer sleeve. A switch 52 may actuate the laser generator
26.
A housing 53 may be attached to the tube 30 adjacent the otoscope
casing and carries a light source 54 which may supply light to an
optical fiber bundle 55, through a lens 56. The bundle carries the
light through an appropriate opening in the housing 14, such as at
18, and is faced so that light exiting the bundle is thrown as a
diffuse light into the operating area, to enhance the viewing by
the operator of the area of the myringotomy.
In the otoscope a strut 58 extending diagonally from top to bottom
of the otoscope 14 carries a laser beam reflecting element 59 faced
diagonally to intercept the laser beam 38 and deflect the beam
toward the opening 18 of the otoscope so that the beam may be
focused appropriately for the proposed myringotomy. The element 59
may be an optically ground and polished quartz or stainless steel
with a polished reflecting surface.
A flexible suction tube 60 may lead from a suction apparatus into
the interior of the otoscope housing through the opening 18, or may
lead along the exterior of the otoscope to withdraw any fumes,
exudate, or the like in the area.
In operation, the operator or surgeon applies the otoscope in the
usual manner to the ear 21 of a patient so that he may view the
tympanum 22. The light from the fibers 55 should be adequate to
give the operator a view of the tympanum surface. The switch 52 is
now actuated and preferably supplies an extremely short burst of
the laser beam 38 which has a focal length determined by the lens
system 37. The operator may judge from this initial burst which may
be of microsecond duration, or the like, and the possible burn
which it inflicts preferably without burning through the tissue,
whether or not the focal length brings the laser beam onto the
tympanum in a desired size, and at the correct place. He then can
adjust the otoscope for placement, and adjust the lens system, as
described, by rotating the outer sleeve 33 to advance or retard the
focal point along the laser beam 61, (after the axis beam
reflection) to afford the desired size of spot. By using very fine
threads, the adjustment may be very close and fine. The operator
may then repetetively actuate the switch to produce the short
bursts until he achieves the desired opening in the tympanum.
If desired, a light source may be located adjacent the strut 58 on
the tube 30 (as indicated in FIG. 3) as by a light source 54a with
optical fiber bundle 55a facing the operating area. Alternatively,
both sources 54 and 54a may be employed.
By making the threads 39 very fine, the motion of the lens system
37 may be adjusted very closely. Thus, rather than adjusting the
focal length by moving one lens relative to another, the entire
lens system is moved, giving a finer, more precise adjustment of
the point along the beam axis at which the focal point of the laser
beam occurs, and giving finer, more precise adjustment of the size
of spot which may be burned by the beam, then by adjusting relative
lens locations of the laser beam lens system.
* * * * *